Kontovazainitis Christos-Georgios, Gialamprinou Dimitra, Fleva Alexandra, Theodoridis Theodoros, Chatziioannidis Ilias, Mitsiakou Christina, Banti Anastasia, Diamanti Elissavet, Mitsiakos Georgios
2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece.
Immunology and Histocompatibility Department, Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece.
Diagnostics (Basel). 2025 Aug 26;15(17):2156. doi: 10.3390/diagnostics15172156.
: Conventional Coagulation Tests (CCTs) fail to accurately reflect Preeclampsia's (PE's) coagulation status, disease progression, and hemostatic alterations. They do not differentiate between the normal hypercoagulability of healthy pregnancies and the pathological hypercoagulability associated with PE. Rotational Thromboelastometry (ROTEM) analyzes clot dynamics from initiation through amplification and propagation to termination and fibrinolysis. However, their application in PE, particularly in neonates born to women with PE, is limited. We aimed to identify the hemostatic alterations in pregnant women with PE using ROTEMs that remain undetected by CCTs and to assess PE's impact on neonatal hemostasis at birth. : This was a single-center observational study (March 2022-March 2024) including 31 women with PE (34 newborns) and 45 pregnancies without PE (47 newborns). Maternal blood was collected intrapartum before placental delivery. Neonatal arterial samples were obtained within the first hour of life before vitamin K administration. ROTEM (Intrinsic (INTEM), Extrinsic (EXTEM), Fibrinogen (FIBTEM), Aprotinin (APTEM)), and CCTs were performed. Subgroup analyses considered PE severity and onset. ROC analyses examined discrimination for persistent maternal thrombocytopenia within 7 days of delivery and association with maternal platelet transfusion. : In preeclamptic women, the INTEM and FIBTEM assays were more affected, with higher Actual Clot Firmness (ACF) ( = 0.03, = 0.04, respectively) and a higher Clot Formation Rate (CFR) ( = 0.03, = 0.02, respectively). Hyperfibrinolysis was present (CT-APTEM < CT-EXTEM, MCF-APTEM > MCF-EXTEM). Clot Formation Time CFT-EXTEM was an indicator of maternal platelet transfusion (AUC = 0.81). Across EXTEM, INTEM, and APTEM, A10 (Amplitude at 10 min) and CFT showed good discrimination capability for maternal persistent thrombocytopenia within 7 days of delivery (AUCs 0.82-0.95). Neonates of women with PE presented lower ACF across all assays (INTEM = 0.003; EXTEM = 0.001; FIBTEM = 0.01; APTEM < 0.001), consistent across severity/onset subgroups. : In this cohort, ROTEM identified maternal hypercoagulability with hyperfibrinolysis and neonatal hypocoagulability during the first hour of life. Several alterations were not reflected in CCTs. Further prospective studies should evaluate the role and clinical utility of combining ROTEM with CCTs for hemostatic monitoring in women with PE and their neonates.
传统凝血试验（CCTs）无法准确反映子痫前期（PE）的凝血状态、疾病进展和止血改变。它们无法区分健康妊娠的正常高凝状态和与PE相关的病理性高凝状态。旋转血栓弹力图（ROTEM）分析从凝血起始到放大、传播直至终止和纤溶的凝块动态变化。然而，其在PE中的应用，尤其是在PE孕妇所生新生儿中的应用有限。我们旨在使用ROTEMs识别PE孕妇中未被CCTs检测到的止血改变，并评估PE对新生儿出生时止血的影响。
这是一项单中心观察性研究（2022年3月至2024年3月），包括31例PE孕妇（34例新生儿）和45例非PE妊娠（47例新生儿）。在胎盘娩出前的产时采集母体血液。在出生后第一小时内、维生素K给药前采集新生儿动脉样本。进行ROTEM（内源性（INTEM）、外源性（EXTEM）、纤维蛋白原（FIBTEM）、抑肽酶（APTEM））和CCTs检测。亚组分析考虑了PE的严重程度和发病情况。ROC分析检查了分娩后7天内持续性母体血小板减少的辨别能力以及与母体血小板输注的相关性。
在子痫前期妇女中，INTEM和FIBTEM检测受影响更大，实际凝块硬度（ACF）更高（分别为 = 0.03， = 0.04），凝块形成率（CFR）更高（分别为 = 0.03， = 0.02）。存在高纤溶状态（CT - APTEM < CT - EXTEM，MCF - APTEM > MCF - EXTEM）。凝块形成时间CFT - EXTEM是母体血小板输注的一个指标（AUC = 0.81）。在EXTEM、INTEM和APTEM中，A10（10分钟时的振幅）和CFT对分娩后7天内母体持续性血小板减少具有良好的辨别能力（AUCs为0.82 - 0.95）。PE孕妇的新生儿在所有检测中ACF均较低（INTEM = 0.003；EXTEM = 0.001；FIBTEM = 0.01；APTEM < 0.001），在严重程度/发病亚组中一致。
在该队列中，ROTEM识别出母体在出生后第一小时内存在高凝伴高纤溶状态以及新生儿低凝状态。一些改变未在CCTs中体现。进一步的前瞻性研究应评估将ROTEM与CCTs联合用于PE妇女及其新生儿止血监测的作用和临床实用性。
